Maličev Elvira, Maček Kvanka Marjeta, Klemenc Polona, Rožman Primož
Department of Immunohematology, Blood Transfusion Center of Slovenia, Ljubljana, Slovenia.
J Clin Pathol. 2017 Dec;70(12):1084-1087. doi: 10.1136/jclinpath-2017-204498. Epub 2017 Sep 13.
Heparin can induce the formation of antibodies against a heparin complex with a platelet factor 4 (PF4), leading to platelet activation and the development of heparin-induced thrombocytopaenia (HIT). Because screening ELISA does not discriminate between platelet activating and non-activating anti-heparin/PF4 antibodies, each positive result is confirmed by an additional functional assay. We analysed 1004 sera of patients with suspected HIT. Optical density (OD) values of ELISA-positive results were correlated with the risk for a positive result with our functional flow cytometric assay. Only 10.7% were ELISA positive and 59.8% of those were positive with the functional assay. The positive functional assay was found in 23.4% of patients with OD<1.0, in 57.7% with 1.0<OD<2.0 and in 94.1% with OD>2.0. Although our results showed that higher ELISA OD values increasethe possibility of the presence of platelet-activating anti-heparin/PF4 antibodies , there is no need for improving ELISA cut-off value for positive result.
肝素可诱导产生针对肝素与血小板因子4（PF4）复合物的抗体，导致血小板活化及肝素诱导的血小板减少症（HIT）的发生。由于筛查酶联免疫吸附测定（ELISA）无法区分血小板活化型和非活化型抗肝素/PF4抗体，因此每个阳性结果都需通过额外的功能检测来确认。我们分析了1004例疑似HIT患者的血清。ELISA阳性结果的光密度（OD）值与我们的流式细胞功能检测呈阳性结果的风险相关。仅10.7%的患者ELISA呈阳性，其中59.8%的患者功能检测呈阳性。在OD<1.0的患者中，23.4%功能检测呈阳性；在1.0<OD<2.0的患者中，57.7%功能检测呈阳性；在OD>2.0的患者中，94.1%功能检测呈阳性。尽管我们的结果表明，ELISA OD值越高，存在血小板活化型抗肝素/PF4抗体的可能性越大，但无需提高ELISA阳性结果的临界值。
